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Skills

  • Conflict resolution
  • Problem resolution
  • Healthcare policies and procedures
  • Budgets
  • Stakeholder relationship management
  • Appeals case management
  • Cross-functional collaboration
  • Program equipment
  • Regulatory compliance
  • Compliance Monitoring

Work Experiences

  • Adjustments, premiums, and refunds were all calculated by me.
  • Achieved a 57% improvement in audit compliance.
  • Communicated with clients, distributed mail, and scanned documents as part of my administrative duties.
  • Solved procedure issues, improved operations, and provided excellent customer service.
  • Achieved favorable outcomes for 11 clients.
  • Pushed for operational changes that resulted in cost savings and higher profit margins.
  • Achieved results within 18 months.
  • Compiled comprehensive appeal case histories and prepared documentation for up to 2 client arbitrations per two years.
  • Authored weekly reports for upper management detailing appeal progress, trends, and potential legal action, leading to actionable insights.
  • Processed 12 invoices and mailed documentation to clients each several months.

Summaries

  • Empathy, dependability, and enthusiasm for customer satisfaction.
  • Over 14 years of experience obtaining information from policyholders and assisting with claim forms as an honest Insurance Clerk.
  • Expert at providing insurance coverage advice to current and potential clients, as well as processing applications, payments, and corrections.
  • Senior Appeals Coordinator with 3 years of successful risk assessment and stakeholder engagement experience.
  • Clear understanding of workflow optimization and vendor management as well as workflow optimization training.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Achieved financial recovery of over $17.
  • Proficient in Microsoft Excel, as well as a dependable nature and a resourceful problem-solving approach.
  • Accomplished Senior Appeals Coordinator.
  • Senior Appeals Coordinator is a multi-talented Senior Appeals Coordinator who is consistently rewarded for planning and operational improvements.

Accomplishments

  • Developed and implemented a centralized appeals tracking system that improved resolution times by 53%.
  • Trained a team of 3 specialists on best practices for navigating insurance appeals and denials, increasing team productivity by 43%.
  • Established an appeals escalation process, resulting in a 83% faster resolution rate for high-priority client concerns.
  • Evolved data collection strategies by integrating Microsoft Excel for faster claim assessments, boosting case closure rates by 22%.
  • Documented and resolved framework which led to process.
  • Built strong relationships with external appeal review committees, achieving a 51% increase in overturn rate for client cases.
  • Earned Innovation Award for reducing appeal processing time by 24% while maintaining 40% accuracy in adjudication.
  • Ensured compliance with state and federal regulations by monitoring all active appeals, resulting in zero regulatory infractions.
  • Proactively identified process improvement opportunities within the appeals function, leading to a 55% reduction in manual errors.
  • Closed 2 high-value appeals within 2019, contributing to a company savings of $3.

Affiliations

  • International Association of Administrative Professionals
  • National Association of Insurance and Financial Advisors (NAIFA)
  • Society of Human Resource Management
  • American Marketing Association
  • American Medical Informatics Association
  • Credentialing Resource Center (CRC)
  • Project Management Institute
  • Certified in Healthcare Privacy and Security (CHPS)
  • Jaycees
  • Insurance and Claim Processing Specialists (ICPS)

Certifications

  • Certified Professional in Utilization Review
  • Certified Business Analysis Professional (CBAP)
  • Microsoft Certified Systems Engineer (MCSE)
  • Google Certified Professional Cloud Architect
  • Lean Six Sigma Black Belt Certification
  • CompTIA Security+
  • Health Care Compliance Association (HCCA) Certified Compliance Professional (CCP)
  • Salesforce
  • Risk Adjustment Coding Certification (CRC) by Meridian
  • CompTIA Network+

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